The COVID-19 pandemic necessitated the increased use of telemedicine for clinicians across the country, as noted by Herdes et al. [1] in their article describing the impact of telemedicine on attendance rates at a pediatric quaternary care bariatric surgery program. It is wise to use this necessitated change in healthcare delivery to study telemedicine’s impact on access to care and outcomes for patients. Metabolic and bariatric surgery is the most effective treatment option for severe obesity in children [2]. Unfortunately, bariatric surgery remains inaccessible and underutilized by the majority of eligible patients for a variety of reasons: there are not enough bariatric surgeons or programs offering services to children and adolescents with severe obesity; there are inconsistent and onerous insurance requirements to prove medical necessity; there is a societal bias that severe obesity is best treated by individual lifestyle modification alone; and there are concerns that the risks of bariatric surgery outweigh the benefits.
Hopefully, one of the positive side effects of living and working through the COVID-19 pandemic will be the increased use and continued payment for medical services delivered via telemedicine. As mentioned by the authors, telemedicine is thought to improve access to care by making visits more time and cost efficient by reducing the need for travel. This type of care delivery seems especially suitable for visits, such as obesity treatment, that are counseling intensive. In addition, behavioral or lifestyle challenges are influenced by the physical environment. If permitted by patients, telemedicine can increase a medical provider’s visual understanding of the opportunities and barriers present in our patients’ and families’ home environments. Lastly, while not addressed or looked at in this study, the ability to convert an in-person visit to telemedicine may reduce visit cancellations rates. As noted in the article, this is especially important considering the fact that there is a 27% to 73% attrition rate in pediatric weight management programs [3].
While telemedicine certainly has potential benefits when it comes to access to care, there remain challenges and many unanswered questions. Could the use of telemedicine inadvertently widen disparities of care by excluding patients and families without appropriate technology available in their homes? Will the preferences and benefits of telehealth delivery be the same for English and non-English speakers? Specific to obesity treatment, how will proper measurement and collection of vital signs like weight and blood pressure be ensured? This could be especially problematic if a patient does not have access to a reliable digital scale or sphygmomanometer and is having rapid worsening of weight status or is on a weight loss medication that could raise blood pressure. Future studies should look at short- and long-term outcomes of the use of telemedicine in obesity treatment to answer some of these questions. Concerns remain about the possible loss of the benefits and convenience of telemedicine now that the shelter-in-place mandates have been lifted. In pediatric medicine, there is the added complication of having a parent–child dyad. Often the parent and child have their individual responsibilities such as work and school and are not co-located the majority of the time. Lastly, it is logistically complicated for medical providers to offer multidisciplinary care both in-person and via telemedicine during dedicated clinical time.
Even with the many challenges and unanswered questions, the hope is that telemedicine will help break down some of the barriers to quality obesity treatment. The study by Herdes et al. is one of the first to describe positive benefits to this novel mode of healthcare delivery specific to a pediatric metabolic and bariatric surgery program population.
Disclosures
The author has no commercial associations that might be a conflict of interest in relation to this article.
References
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